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Table 4 Quotations: Trust and credibility

From: Evidence-based medicine in primary care: qualitative study of family physicians

"This is where I have a real problem. The evidence base is driven by profit. More and more, it's driven by profit. Nobody's doing the studies with medications that already exist but are off patent. Nobody's doing the studies with simple interventions like making sure that single moms have relief. So if I just go by what there's evidence for, I end up participating in this industrial complex." FP05
"Something I'm intensely aware of at all times is the degree to which the information source is promoting a drug company agenda. Certainly with all the freebie journals that we get I look at them with an extremely skeptical eye to the point of not even looking at them for the most part, but they do have the occasional useful bit so I tend to filter very, very heavily." FP01
"The absolute worst are new drug trials... It's very typical that these are funded by drug companies. They're low quality, not taking into account side effects of the drugs, there's not a long enough follow-up so that you could properly judge whether the drug is safe or not, and they use ways of assessing effectiveness that favour the drug." FP02
"It would be nice if there was more pure research done through academic agencies who are independent of drug companies. Then you wouldn't have to worry about removing that one bias – it just wouldn't be there to begin with... In the real world, drug companies are going to be funding a lot of the research, so you've got to be aware of that all the time as a clinician down at my end, far removed from the research." FP13
"I think it can limit advancement because a lot of the 'evidence-based medicine' is conducted by drug companies, and I have a big issue about that.... I think it's unfortunate that drug companies have so much influence on the things that are studied. For instance, I think natural therapies and complementary therapies is one area that really needs to be researched, but it probably won't because they can't get patents on it." FP07
"I think EBM is predicated upon there being well-supported and financed independent reviewers who are doing the meta-analyses and the broader views which have become the key to evidence-based medicine." FP01
"I don't want to transfer authority from the individual physician to the pharmaceutical companies or to the vested interests and I think that's what we're in danger of doing. The evidence isn't clean, so much so now that respected journals are struggling not to accept tainted evidence and still keep their heads above water. There are terrible influences on them." FP05
"In my view, not all publications are equal in that those published by drug companies and those in more marginal journals are frequently more marketing than they are true science. Even with those of quite high quality, they often go through huge amounts of selection with inclusion/exclusion criteria such that the results are probably most applicable to only a small portion of a family doctor's population, but that is not stressed enough in the papers. The results and the discussion tend to focus mostly on the successful nature of the medication without incorporating enough of the appropriate cautions and limitations of where this information should be applied." FP02
"The difficult problem with evidence-based medicine is that in order to produce a high quality trial you need to have a certain amount of funding and there are probably ways that things can be manipulated so that you can get that trial off the ground and published with a particular result.... Then there are the pharmaceutical companies, which choose not to publish results of trials they've conducted that don't show a difference. They just won't get seen. So you can't put all your eggs in the basket of evidence-based medicine." FP12